Medicaid Expansion Now in States' Hands

Hospitals are facing a showdown with state officials over the U.S. Supreme Court's decision on the expansion of Medicaid under the Patient Protection and Affordable Care Act.

Last week the court ruled that states couldn't be coerced into agreeing to the expansion, which would have added an estimated 17 million to the Medicaid rolls. Instead, states may simply decide not to participate in the expansion, which is 100% financed with federal funds for the first three years and then 90% covered for the next seven.

Almost immediately after the release of the Supreme Court decision Republican-led states began announcing that they would not participate in the expansion. In Florida, which was behind the legal challenge to the Medicaid expansion and where four million people are uninsured, Gov. Rick Scott (R) at first suggested that he might be amenable to the expansion, but by Monday stood firmly opposed to it.